Opinion 2.23 - HIV Testing

Physicians’ duties to promote patients’ welfare and to improve the public’s health are fostered by routinely testing their adult patients for HIV. Physicians must balance these obligations with their concurrent duties to their individual patients’ best interest by following the guidelines below:

(1) In order to protect patients, avoid injury to third parties, and promote public health, physicians should support routine universal screening for HIV with opt-out provisions.

(2) Although medical and social advances have minimized the need for specific written consent prior to HIV testing, the ethical tenets of respect for autonomy and informed consent require that physicians continue to seek patients' informed consent to undergo any form of medical treatment, including refusal of HIV testing. Given the potential benefits to a patient (and the patient’s intimate others) of knowing his/her HIV status, it is appropriate for physicians to make efforts to persuade reluctant patients to be screened. Physicians should, however, respect the decision of a patient who “opts out.” Unless required by law, patients’ consent to HIV testing does not need to be documented in writing. However, the conversation concerning testing should be documented in the patient's chart. It is justifiable to test patients without prior consent only in limited cases where the harms to individual autonomy are offset by significant benefits to known third parties. Such exceptions include testing for the protection of occupationally exposed health care professionals or patients.

(3) Physicians must work to ensure that patients identified as being HIV positive receive appropriate follow-up care and counseling.

(4) Physicians must comply with all applicable disease reporting laws while taking appropriate measures to safeguard the confidentiality of patients' medical information to the extent possible.

(5) Physicians must honor their obligation to promote the public's health by working to prevent HIV-positive individuals from infecting third parties within the constraints of the law. If an HIV-positive individual poses a significant threat of infecting an identifiable third party, the physician should:

(a) notify the public health authorities, if required by law;

(b) attempt to persuade the infected patient to cease endangering the third party; and

(c) if permitted by state law, notify the endangered third party without revealing the identity of the source person. (I, IV, VII)